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New Mexico rates for HCPCS 50575

Renal endoscopy through nephrotomy or pyelotomy, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service; with endopyelotomy (includes cystoscopy, ureteroscopy, dilation of ureter and ureteral pelvic junction, incision of ureteral pelvic junction and insertion of endopyelotomy stent)

Insurance Carrier
Aetna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$1,000.00 / $1,023.29 / $7,762.47
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$660.69 / $812.83 / $1,737.80
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,096.48 / $1,348.96
Molina
Facility/Professional
Professional
Modifier
Low / Median / High Price
$32.36 / $33.11 / $1,023.29
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$776.25 / $1,096.48 / $1,862.09
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$588.84 / $1,047.13 / $1,348.96
United
Facility/Professional
Facility
Modifier
Low / Median / High Price
$891.25 / $11,220.18 / $23,442.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$831.76 / $1,096.48 / $1,621.81